Patient predictors of follow-up care attendance in Roux-en-Y gastric bypass patients
Abstract
Background Multidisciplinary care after bariatric surgery is important for long-term safety and optimal weight loss, yet many patients do not attend follow-up appointments. We sought to identify demographic, psychosocial, and weight-related variables that were associated with medical and behavioral health appointment attendance after bariatric surgery.Methods A retrospective chart review was conducted with consecutive patients (n=538) obtaining first-time Roux-en-Y gastric bypass surgery between August 2009 and August 2010. Demographic and psychosocial data were compared between high (>50%) and low (≤50%) medical appointment attendees and high (>50%) and low (≤50%) behavioral health group attendees in their first postoperative year. Percentage excess weight loss at 6 months after surgery was evaluated as a predictor of 12-month appointment attendance.Results High medical appointment attendees were more likely to be older, be Caucasian, and have lower phobic anxiety than low medical appointment attendees. High behavioral health attendees had shorter travel distance to the clinic and lower levels of hostility, anxiety, and phobic anxiety compared with low attendees. In multivariate analyses, race/ethnicity and phobic anxiety remained significant predictors of medical attendance, while travel distance to clinic predicted behavioral health attendance. Six-month percent excess weight loss predicted medical appointment attendance at 12 months.Conclusion The identified predictors of poor attendance at medical and behavioral bariatric surgery follow-up appointments should inform efforts to increase follow-up and improve surgical outcomes.
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Four other studies found no link between pre-operative depression and adherence to follow-up appointments.
“However, four other studies found no link between pre‐operative depression and adherence to follow‐up appointments. 20 , 21 , 22 , 23”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
Higher levels of pre-operative phobic anxiety were associated with a lower likelihood of appointment attendance in the first 6-12 months post-surgery.
“In studies examining anxiety, higher levels of pre‐operative phobic anxiety 20 and an avoidant attachment style were associated with a lower likelihood of appointment attendance in the first 6–12 months post‐surgery. 21”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
Pre-operative alexithymia was not significantly related to follow-up appointment adherence.
“pre‐operative emotional/internalizing dysfunction, 24 hostility, interpersonal sensitivity, alexithymia, 20 and maladaptive eating attitudes and habits 23 were not significantly related to follow‐up appointment adherence.”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
There was no significant link between adherence and generalized anxiety in other studies.
“However, there was no significant link between adherence and generalized anxiety 15 , 20 or an anxious attachment style 21 in other studies.”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
Travel distance may explain behavioral group attendance over and above psychosocial factors.
“which suggests that it may explain behavioral group attendance over and above psychosocial factors.”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
Travel distance remained a significant predictor in the regression.
“Travel distance remained a significant predictor in the regression”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
Patients who attended fewer than two out of four behavioral groups in the first 12 months after surgery were more likely to have higher levels of pre-operative hostility, generalized anxiety, and phobic anxiety compared to those who attended three to four groups.
“That study found that patients who attended fewer than two out of four behavioral groups in the first 12 months after surgery were more likely to have higher levels of pre‐operative hostility, generalized anxiety, and phobic anxiety compared to those who attended three to four groups. 20”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
When hostility, anxiety, and phobic anxiety were included as predictors alongside travel distance in a multivariate logistical regression, the psychosocial variables were no longer significantly predictive of group attendance.
“When hostility, anxiety, and phobic anxiety were included as predictors alongside travel distance (i.e., between the bariatric clinic and patients' homes) in a multivariate logistical regression, the psychosocial variables were no longer significantly predictive of group attendance.”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
The differences in pre-operative hostility, generalized anxiety, and phobic anxiety between attendance groups were only significant in univariate analyses.
“However, these differences were only significant in univariate analyses.”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
One study reported negative correlations between support group attendance and pre-operative hostility and anxiety, but these relationships were no longer significant once travel distance was taken into consideration.
“Although one study reported negative correlations between support group attendance and pre‐operative hostility and anxiety, these relationships were no longer significant once travel distance was taken into consideration. 20”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
Generalized anxiety, phobic anxiety, and attachment anxiety were identified as barriers to adherence in some studies, but other studies did not find a significant association between generalized anxiety and post-operative adherence.
“Generalized anxiety, 31 , 32 phobic anxiety, 20 and attachment anxiety 31 were identified as barriers to adherence in some studies, but other studies did not find a significant association between generalized anxiety and post‐operative adherence. 15 , 20 , 30”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [20]
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- Authors
- McVay, M. A., Friedman, K. E., Applegate, K. L., & Portenier, D. D.
- Affiliations
- Duke Medical Center (US)
- Duke University Health System (US)
- Corresponding author
- McVay, Megan A.
- ORCID
- McVay, Megan A.
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2013-11
- Volume
- 9
- Issue
- 6
- Pages
- 956-962
- ISSN
- 1550-7289 (ISSN-L)
- OpenAlex
- W1971920121
- Cited by
- 74
- References
- 23
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 8 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 4 · 2019: 8 · 2018: 10 · 2017: 2 · 2016: 6 · 2015: 7 · 2014: 2 · 2013: 2
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (T32HS000079)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Keywords
- Roux-en-Y gastric bypass, bariatric surgery
- MeSH terms
- Adult, Age Factors, Anastomosis, Roux-en-Y, Attitude to Health, Continuity of Patient Care, Female, Follow-Up Studies, Humans, Male, Middle Aged, Monitoring, Physiologic, Obesity, Morbid, Patient Compliance, Predictive Value of Tests, Retrospective Studies, Sex Factors, Time Factors, Cohort Studies, Gastric Bypass, Health Behavior, Risk Assessment
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